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HomeMy WebLinkAboutCC 4 CLAIM #89-52 06-18-90CONSENT CALENDAR NO. 4 6/18/90 Inter - Com DATE: JUNE 61 1990 • 4s- Jl_ r s E_. l TO: HONORABLE MAYOR AND CITY COUNCIL JUN 8 1990 FROM: CITY ATTORNEY SUBJECT: CLAIMANT: NICK DRAGONOV; D/L: 12/15/89; DATE FILED W/CITY: 12/27/89; CLAIM NO: 89-52; CARL WARREN FILE NO: S 6011 PRL After investigation and review it is recommended that the above -referenced claim be rejected and the City Clerk directed to give proper notice of the rejection to the claimant and to the claimant's attorney. J0FT,. 'wROTJRKE City Attorney JGR:kbg(claim.frm) Enclosure: Copy of Claim ;;LA1M AGAlN61: Th t; k-ITY ur 1.u0l1114 , l•Fo'r' Damages to Person -')or Personal Property) Received by � L� via IT_S . Mail ter -office Maid u,er the Counter The law provides generally that a claim must be filed with the City Clerk of the City of Tustin within 100 days after -which the incident or event occurred Be sure your claim is against the City of Tustin, not another public entity. Where space is insufficient, please use additional paper and identify informa• tion'by paragraph number. Completed claims must be mailed or delivered to th( City Clerk, The City of Tustin, 300 Centennial Way, Tustin, California 92680 TO -THE HONORABLE MAYOR AND CITY COUNCIL, City of Tustin, California: The undersigned respectfully submits the following claim and information.rela- tive to damage to persons .and/or personal property: 1. NAP -4E OF CLAIMANT: lJ� v � a. ADDRESS OF CLAIMANT: b. PHONE NO: ( / C. DATE OF BIRTH: � SOCIAL DRIVERS d. SECURITY NO: e. LICENSE NO: 2. Name, telephone and post office address to which claimant desires notices to be sent, if"other than above: This claim is submitted against: a. The City of Tustin only. b. The following employee(s) of the City of Tustin only: C. The City of Tustin and the following employee(s) of the City of Tustin only: 4. Occurrence or -event from which the claim arises: a. DATE: ���` 9�j b. •TIME: 2('*.h• c. PLACE (Exact and specific location): (/U2- d. flow and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or omission you claim caused the injury or damage (Use additional paper if necessary). , r10n n) C J :-r' FAN.. <E+,�nc� , w.i r r_/V'TY/__ /00T_ (>4•"' 4�A-l! Ni Give a description of injury, property damag_ loss so far as is known at the time of t. claim. If there were n n]uries, state "no njuries". �. Ar! iv�cam' -or D l U Z (� 1� f�� fl TWv i r --OP % i /14 Oft 2z 6 -70 &PAlo A-91 Ivtr 0A r1or'� f'�o ,CJS TZ OF /Mf -f eT w, 77Y /}S �. Give the name (s) of the City employee (s) causing the -damage or injury: Name and address of any other person injured: Name and address of the ower of any damaged property: ). Damages claimed: a. Amount claimed as of this date: / b. Estimated amount of future costs: PA111,A17 u►til C . Total amount claimed : _� "S `}?OP -f ,?C -bills d. Basis for computation of amounts claimed (include copies o all , invoices, estimates, etc.: I�o►�- 71 M's�z -t- - -0. Names and addresses of all witnesses, hospitals, doctors, etc.: a b. - r, _ d. ny additional information that might be helpful in considering this claim: ARNING : IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM ( Penal Code Section 72; Insurance Code Section 556-0) have read the matters and statements made in the above claim and I know the Same to be true of my own knowledge, except_as to those matters stated to be ;_con information or belief and as to such matters I believe the same to be true.. T certify under penalty of perjury that the foregoing is TRUE AND CORRECT. _ executed this 2 7 day of �r�r��-- 19 r� at Tustin, California. IMOT ' S SIGNATURE -)_ fice of the City Clerk, ` _'ustin, California 1 NO: DATE FILED: devised 8/05/81 7GR: se : R: 8/5/81 (A) . t 4 1� r B. A. R. # l r AJ -105305 Joe LgacPHE RS ON' CAUTION: PLEASE SEE OUR SERVICE ADVISOR REGARDING NEEDED SERVICE TOYOTA 44 AUTO CENTER DR. 2. TUSTIN, CA 92680 3. C� (714) 832-3355 4. ALL PARTS INSTALLED ARE NEW UNLESS SPECIFIED OTHER - CUSTOMER ACKNOWLEDGES RECEIPT OF COPY HEREOF WISE. ALL NEW REPLACEMENT PARTS AND LABOR HAVE A LIMITED WARRANTY FOR 6 MONTHS OR 6.000 MILES. SIGNED AND WHICHEVER COMES FIRST. RECEIPTED X DRAGANOV, N 1 C:K'- ,. C F' i;l:l t=:i >c.�2�.�I L I ' ;VI_: DATE LII.INE 12 /2_'� /;`.,., HOME - I_'_'i' 17: 0c_5: 17 (_m •c z ---------------------------------------------------------------------------- — < ABOR 1= K% FCIR S'T I FF `':TEER I NI 1 SINCE H I TT I 1 -EC 1 12'2 1.0 47 . ji � n >, N51 NG BLIMP 51 : � � a PARTS laRDERED I I COMPLETED- o FART'= TOY 4512o52.80:_:0 *TUBE /A TY 1 :/., 26. 52' t..-� TOY 452 52, 28o5(C, *TUBE, ' 'f 1 _= i � :_' , cj T TOY 45292,28. � 1 c-� # =.EAL , MAI 1 1 6. 1.c* 1 I.. 65 .0 TOY 4 C • ✓' 10 ter' , • 1*SHAFT 1-f- - 221- • 26' TOY 96152c:0=:i)CI *RINCS,'STR 1 . 5 . 52: 0 TOY z'526, _-.3 :0 1 0 *R I NI , I_ I I1_ 1 1 iS5 .l 6.-1 TOY 4r i252 101B L 0 CK, u J!= - TOY c,TOY 9c_i'6 3 1;E:o *BEARING 1 r, TOY 453 10 2, 4 1 *HOUSING i FARTS AM'fC•:=: �. 2c:� T1�'f LINE 70/• . -----------------------------------------•---------------------------------I�It: LABC)R CK FOR HORk.' HONf-":; WHEN T; fRN I N1 TEI^ 1 12 . 0 - - , LN512' STEER 1 NI_ WHL (HIDRr%.I LII 3C ONES :TELT) NC � FART ORDERED COMPLETED TOT I- l NE . t t ------------- ---------------------------------------------------- PARTS —-------•-------_----------------•------•-------- — F'AR I"S 6c._:9. 20 9 LABOR—MECHANICAL 47. i C) TAX .4 6 TOTAL CHARCIES 779 , 26 - MEI_H LAP -OR 12.� 47. c:lc TO 1' 47. 0C PAGE 1 CiF C. CUSTOMER COPY ON LINE SERVICE INVO!CING BY UNIVERSAL COMPUTER SYSTEMS, INC i.. rt Nat JI �,f"`4 h �.5 �_ "},' ",k . y,a YYC'•'M' Y;=,✓ 5 .,;tr .. Joe Msi erj Toyota TIMATE ANDS REPAIR ORDER 9' v �•'rWk� �t'n�r¢t:3L "'i..'� "'�' / t ✓. F " 'tt-r't ix : 4: .hrR 1 r� (714).832 3355`- „� c .,, x'tl ... as:. .,ir?i`%xi;� Y,♦ ,yps,r.�, `+r Rc . 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Rot+�y�,. i- I t 5 5nir•`( J b,""V .\.i'� py,E -..fi" F- .j: * s,'F iia+ :;' i. ♦ 4 h.♦. +, wf _'+ab` �+^!: sk, tk'�4"tt'A www' �ix% Rvei^•. • �^ tl*�4YaII ./ - t ? *'. '� .ii «9�.� tx' tlf �. %F§.x: �+d .�):fY• T�, y{ �.a...- N .. '{�,`_,`,'� iM.i'^^e ?3,,..� •S:.:v SS L t �' tt ,{ rt .•,j,"yW'^�."y {`+ 54 "•,'` ti rw � T X�: �� � "4:M .fl f - iii ),• i - ,y' 1ct' ffl4af+tt433 ^ :'i i"} 9hx'• gw 5y' ulr:.' Y 't'3., „� 2 , $ k '4' 4yk � �4 b '#y'k n �k �. :f' �, .�}'tA� ��P e' i�" � i"',.+•.• "i'Y _ `Z,♦g f s� #➢4-- 4 V y �' 7 �"Gx Cg w-♦ "� d f v k fi.'C t. ,•3+ - < C R 'A ' T 'ap fie" y 9.t i'� x r" RR'+r w7 *.F' � l` x to � 3 � fF:�,,4 ^eSsy;�':'f�^s'�,'Fs�^, �j„ t� � �, y_f �•r � `�ftr � �� � � hti:� ,. .. '. 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